Depressive disorders are twice as prevalent in women as in men and frequently comorbid with gynecologic disorders such as urinary incontinence (UI). OB-GYNs have exceptional access to women during the reproductive years, which is the time of peak incidence of depression. OB-GYNs therefore have a unique but unrealized opportunity to detect and initiate treatment or referral for depression in reproductive age and postmenopausal women. The increased prevalence of current major depression in women with UI indicates that this disorder may provide a useful avenue for improving detection of depression in the OB-GYN clinical setting. The goal of this 5-year Mentored Patient-Oriented Research Career Development Award is to enable the applicant to obtain the necessary skills and training to become an independent women's mental health investigator working at the interface of Psychiatry and OB-GYN, with specific focus on elucidating interactions between depression and UI and on developing health services interventions to improve treatment outcomes of depression in women with UI in the OB-GYN clinical setting. This career development award will consist of coursework, mentorship, and supervised investigations focusing on: 1) determining the prevalence and impact of major depression in women with UI, 2) examining reciprocal relationships between major depression and UI, and 3) developing health services interventions in the OB-GYN clinical setting to improve treatment outcomes of depression in women with UI. Career development activities will be applied to three mentored research studies. In Study 1, analyses of two existing population data sets will be used to develop a conceptual framework for the relationship between major depression and UI in women. In Study 2, in-depth qualitative assessments of women with major depression and UI will assess how incontinent women with depression view their depression and how comorbid disease influences illness perceptions and care seeking behaviors. In Study 3, findings from Studies l and 2 will be integrated with award training activities to design and implement a pilot intervention to improve treatment outcomes of depression in women with UI in the OB-GYN clinical setting. Results from this study will be used to prepare an R01 clinical effectiveness trial. This K23 award will enable the applicant to bridge the gap between OB-GYN and mental health services research, an alignment that is necessary to integrate these fields and improve women's mental health. The award will provide crucial support for the applicant's ongoing development as an investigator in the area of depression in women.